decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Copayment_Deductible_Waivers / Waivers_and_the_usual_and_customary_charge
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Article Overview
This article explains the relationship between patient cost-sharing collection practices and how carriers may view a provider’s usual, customary, and actual charges. It is aimed at billing, compliance, and coding professionals who need a general understanding of Medicare-related charge evaluation and the risks associated with routine waiver practices.
Why This Topic Matters
Providers and billing staff need to understand how consistent non-collection of patient responsibility can affect charge reporting and payer review. The topic is important for compliance, reimbursement integrity, and maintaining defensible billing practices.
What You Will Learn
- How patient cost-sharing collection practices can affect carrier perceptions of provider charges
- How Medicare-related charge evaluation considers customary and actual billed amounts
- Why routine waiver practices may draw carrier review
- How advertised free services relate to charge evaluation concerns
Who Should Read This
- Medical coders
- Billing specialists
- Compliance professionals
- Practice managers
- Physician offices
- Supplier organizations
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